Development and Evaluation of Management Programs to Reduce the Average Length of Stay (LOS) in Emergency Departments (ED)

Emergency departments (EDs) are increasingly used for patients at the end of life stage of their diseases worldwide, even if they do not have acute and potentially treatable conditions. Moreover, an increasingly shortage of hospital beds, in spite of the wellrecognized ageing of the population, has led to a progressive prolongation of the average length of stay (LOS) time in the vast majority of Italians EDs. Therefore, the aim of this study was to describe the trend of ED non-traumatic deaths in 11 Italians EDs, and to correlate these deaths with the medium length of stay in the same EDs. All cases classified as “died during ambulance transfer or while in the ED” have been retrieved from the hospital database of the 11 participating EDs, from January 1st 2007 to December 31st 2016, with the exclusion of traumatic events. The average LOS in minutes of the seven hospitals that could provide this information was then calculated. A continuously increasing number of ED deaths was observed in the vast majority of participating EDs, showing a nearly 30% increases in the last four years. The average LOS of the vast majority of participating hospitals displayed a significant increase during the observational period. We also found a linear correlation between average LOS and total number of ED deaths in the same seven hospitals. We believe that there is a compelling need to reconsider the end of life trajectories, not only under an economical perspective, but mainly according to a more ethical view.

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Colonization and Infection With MRSA and CRKP and Its Result in an Increased Mortality Rate Within the Intensive Care and High-Dependency Units in Barbados

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.703 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s173-s174

Author(s):

Keisha Gustave

Keyword(s):

Intensive Care ◽

Length Of Stay ◽

High Mortality ◽

Average Length ◽

Cohort Analysis ◽

Health Concern ◽

Queen Elizabeth Hospital ◽

Surveillance Program ◽

Average Length Of Stay ◽

High Dependency

Background: Methicillin-resistant Staphylococcus aureus(MRSA) and carbapenem-resistant Klebsiella pneumoniae (CRKP) are a growing public health concern in Barbados. Intensive care and critically ill patients are at a higher risk for MRSA and CRKP colonization and infection. MRSA and CRKP colonization and infection are associated with a high mortality and morbidly rate in the intensive care units (ICUs) and high-dependency units (HDUs). There is no concrete evidence in the literature regarding MRSA and CRKP colonization and infection in Barbados or the Caribbean. Objectives: We investigated the prevalence of MRSA and CRKP colonization and infection in the patients of the ICU and HDU units at the Queen Elizabeth Hospital from 2013 to 2017. Methods: We conducted a retrospective cohort analysis of patients admitted to the MICU, SICU, and HDU from January 2013 through December 2017. Data were collected as part of the surveillance program instituted by the IPC department. Admissions and weekly swabs for rectal, nasal, groin, and axilla were performed to screen for colonization with MRSA and CRKP. Follow-up was performed for positive cultures from sterile isolates, indicating infection. Positive MRSA and CRKP colonization or infection were identified, and patient notes were collected. Our exclusion criteria included patients with a of stay of <48 hours and patients with MRSA or CRKP before admission. Results: Of 3,641 of persons admitted 2,801 cases fit the study criteria. Overall, 161 (5.3%) were colonized or infected with MRSA alone, 215 (7.67%) were colonized or infected with CRKP alone, and 15 (0.53%) were colonized or infected with both MRSA and CRKP. In addition, 10 (66.6%) of patients colonized or infected with MRSA and CRKP died. Average length of stay of patients who died was 50 days. Conclusions: The results of this study demonstrate that MRSA and CRKP cocolonization and coinfection is associated with high mortality in patients within the ICU and HDU units. Patients admitted to the ICU and HDU with an average length of stay of 50 days are at a higher risk for cocolonization and coinfection with MRSA and CRKP. Stronger IPC measures must be implemented to reduce the spread and occurrence of MRSA and CRKP.Funding: NoneDisclosures: None

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Temporal Changes in Central-Line–Associated Bloodstream Infection Time Between Events, 2017–2018 Versus 2015–2016

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1051 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s403-s404

Author(s):

Jonathan Edwards ◽

Katherine Allen-Bridson ◽

Daniel Pollock

Keyword(s):

Length Of Stay ◽

Patient Care ◽

Average Length ◽

Bloodstream Infections ◽

Central Line ◽

Significant Shift ◽

Care Hospital ◽

Average Length Of Stay ◽

Period 2 ◽

Hospital Bed

Background: The CDC NHSN surveillance coverage includes central-line–associated bloodstream infections (CLABSIs) in acute-care hospital intensive care units (ICUs) and select patient-care wards across all 50 states. This surveillance enables the use of CLABSI data to measure time between events (TBE) as a potential metric to complement traditional incidence measures such as the standardized infection ratio and prevention progress. Methods: The TBEs were calculated using 37,705 CLABSI events reported to the NHSN during 2015–2018 from medical, medical-surgical, and surgical ICUs as well as patient-care wards. The CLABSI TBE data were combined into 2 separate pairs of consecutive years of data for comparison, namely, 2015–2016 (period 1) and 2017–2018 (period 2). To reduce the length bias, CLABSI TBEs were truncated for period 2 at the maximum for period 1; thereby, 1,292 CLABSI events were excluded. The medians of the CLABSI TBE distributions were compared over the 2 periods for each patient care location. Quantile regression models stratified by location were used to account for factors independently associated with CLABSI TBE, such as hospital bed size and average length of stay, and were used to measure the adjusted shift in median CLABSI TBE. Results: The unadjusted median CLABSI TBE shifted significantly from period 1 to period 2 for the patient care locations studied. The shift ranged from 20 to 75.5 days, all with 95% CIs ranging from 10.2 to 32.8, respectively, and P < .0001 (Fig. 1). Accounting for independent associations of CLABSI TBE with hospital bed size and average length of stay, the adjusted shift in median CLABSI TBE remained significant for each patient care location that was reduced by ∼15% (Table 1). Conclusions: Differences in the unadjusted median CLABSI TBE between period 1 and period 2 for all patient care locations demonstrate the feasibility of using TBE for setting benchmarks and tracking prevention progress. Furthermore, after adjusting for hospital bed size and average length of stay, a significant shift in the median CLABSI TBE persisted among all patient care locations, indicating that differences in patient populations alone likely do not account for differences in TBE. These findings regarding CLABSI TBEs warrant further exploration of potential shifts at additional quantiles, which would provide additional evidence that TBE is a metric that can be used for setting benchmarks and can serve as a signal of CLABSI prevention progress.Funding: NoneDisclosures: None

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Biased and unbiased estimation of the average length of stay in intensive care units in the Covid-19 pandemic

Annals of Intensive Care ◽

10.1186/s13613-020-00749-6 ◽

2020 ◽

Vol 10 (1) ◽

Cited By ~ 2

Author(s):

Nathanael Lapidus ◽

Xianlong Zhou ◽

Fabrice Carrat ◽

Bruno Riou ◽

Yan Zhao ◽

...

Keyword(s):

Intensive Care ◽

Length Of Stay ◽

Average Length ◽

Parametric Method ◽

Estimation Methods ◽

Unbiased Estimation ◽

Bed Occupancy ◽

Average Length Of Stay ◽

Discharged Patients ◽

First Admission

Abstract Background The average length of stay (LOS) in the intensive care unit (ICU_ALOS) is a helpful parameter summarizing critical bed occupancy. During the outbreak of a novel virus, estimating early a reliable ICU_ALOS estimate of infected patients is critical to accurately parameterize models examining mitigation and preparedness scenarios. Methods Two estimation methods of ICU_ALOS were compared: the average LOS of already discharged patients at the date of estimation (DPE), and a standard parametric method used for analyzing time-to-event data which fits a given distribution to observed data and includes the censored stays of patients still treated in the ICU at the date of estimation (CPE). Methods were compared on a series of all COVID-19 consecutive cases (n = 59) admitted in an ICU devoted to such patients. At the last follow-up date, 99 days after the first admission, all patients but one had been discharged. A simulation study investigated the generalizability of the methods' patterns. CPE and DPE estimates were also compared to COVID-19 estimates reported to date. Results LOS ≥ 30 days concerned 14 out of the 59 patients (24%), including 8 of the 21 deaths observed. Two months after the first admission, 38 (64%) patients had been discharged, with corresponding DPE and CPE estimates of ICU_ALOS (95% CI) at 13.0 days (10.4–15.6) and 23.1 days (18.1–29.7), respectively. Series' true ICU_ALOS was greater than 21 days, well above reported estimates to date. Conclusions Discharges of short stays are more likely observed earlier during the course of an outbreak. Cautious unbiased ICU_ALOS estimates suggest parameterizing a higher burden of ICU bed occupancy than that adopted to date in COVID-19 forecasting models. Funding Support by the National Natural Science Foundation of China (81900097 to Dr. Zhou) and the Emergency Response Project of Hubei Science and Technology Department (2020FCA023 to Pr. Zhao).

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Times of change in complex environments - Evaluating hospital co-payments in Palestine refugee camps

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1252 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

S V Valente de Almeida ◽

H Ghattas ◽

G Paolucci ◽

A Seita

Keyword(s):

Length Of Stay ◽

Policy Change ◽

Negative Binomial ◽

Negative Impact ◽

Average Length ◽

Lessons Learned ◽

Policy Impact ◽

Average Length Of Stay ◽

Ex Post ◽

The Impact

Abstract We measure the impact introducing a of 10% co-payment component on hospitalisation costs for Palestine refugees from Lebanon in public and private hospitals. This ex-post analysis provides a detailed insight on the direction and magnitude of the policy impact in terms of demand and supply for healthcare. The data was collected by the United Nations Relief and Works Agency for Palestine Refugees in the Near East and include episode level information from all public, private and Red Crescent Hospitals in Lebanon, between April 2016 and October 2017. This is a complete population episode level dataset with information from before and after the policy change. We use multinomial logit, negative binomial and linear models to estimate the policy impact on demand by type of hospital, average length of stay and treatment costs for the patient and the provider. After the new policy was implemented patients were 18% more likely to choose a (free-of-charge) PRCS hospital for secondary care, instead of a Private or Public hospital, where the co-payment was introduced. This impact was stronger for episodes with longer stays, which are also the more severe and more expensive cases. Average length of stay decreased in general for all hospitals and we could not find a statistically significant impact on costs for the provider nor the patient. We find evidence that the introduction of co-payments is hospital costs led to a shift in demand, but it is not clear to what extent the hospitals receiving this demand shift were prepared for having more patients than before, also because these are typically of less quality then the others. Regarding costs, there is no evidence that the provider managed to contain costs with the new policy, as the demand adapted to the changes. Our findings provide important information on hospitalisation expenses and the consequences of a policy change from a lessons learned perspective that should be taken into account for future policy decision making. Key messages We show that in a context of poverty, the introduction of payment for specific hospital types can be efficient for shifting demand, but has doubtable impact on costs containment for the provider. The co-payment policy can have a negative impact on patients' health since after its implementation demand increased at free-of-charge hospitals, which typically have less resources to treat patients.

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P17 An audit of Trakcare discharge times for Laparoscopic Cholecystectomy

BJS Open ◽

10.1093/bjsopen/zrab032.016 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

Jacob Rapier ◽

Steven Hornby ◽

Jacob Rapier

Keyword(s):

Laparoscopic Cholecystectomy ◽

Length Of Stay ◽

Initial Data ◽

Best Practice ◽

Average Length ◽

Accurate Data ◽

Day Case ◽

Average Length Of Stay ◽

Number Of Patients ◽

Elective Laparoscopic Cholecystectomy

Abstract Introduction Nationally 61,220 Laparoscopic Cholecystectomies are carried out annually. Those carried out as day-cases reduce providers’ costs and increase income through the best practice tariff. The system in our trust to record discharges is ‘Trakcare’. The aim of this audit was to accurately measure the discharge times of patients undergoing elective Laparoscopic Cholecystectomies, to try and reduce the number of patients recorded as having an overnight stay by accurate data collection. Methods Initial data was collected for all elective Laparoscopic Cholecystectomy discharge times on Trakcare, over a 1 month period. This data was then re-audited prospectively both from Trakcare and discharges reported by nurses/patients. A comparison was then made of Trakcare against reported discharge times. Results Initially 54 operations were recorded, with 30 completed as day cases (55.6%). The re-audited data (on Trakcare) recorded 47 operations, with 15 completed as day cases (37.91%). Of these discharges we were able to capture 26 (55.32%) manually, and 11 were completed as day cases (42.31%). Measuring these 26 with the same operations on Trakcare we were unable to show a difference in the number of cases completed as a day case (11 vs 11), with only a 33 minute decrease in the average length of stay. Conclusion Trakcare is a reliable tool for measuring the date of discharge for patients. The recommendations in are: scheduling surgery for a time pre-13:00 shows a higher proportion of patients discharged the same day, and continue to use Trakcare to record discharge times.

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Total Population Estimate of Newborn Special-Care Bed Needs

PEDIATRICS ◽

10.1542/peds.75.6.993 ◽

1985 ◽

Vol 75 (6) ◽

pp. 993-996

Author(s):

August L. Jung ◽

Nan Sherman Streeter

Keyword(s):

Length Of Stay ◽

Total Population ◽

Average Length ◽

Special Care ◽

Care Hospital ◽

Total Hospital ◽

Live Births ◽

Average Length Of Stay ◽

Study Results ◽

Hospital Days

In 1977, 7% of the 38,855 infants born in Utah were estimated to have required a total of 27,439 special-care hospital days. About half (53%) were mildly ill; their average length of stay was 4.6 days, or 24% of the total hospital-days. Another 20% of the infants had intermediate illness, with a 12-day average stay, or 23% of the total hospital-days. The remaining 27% of the infants required intensive care and used 53% of the total hospital-days; their average length of stay was 20 days. As a total population, the state's 38,855 births generated a need for two beds per 1,000 annual live births in special-care facilities. The estimated bed need was: mild illness (Level I), 0.5 beds per 1,000 annual live births; intermediate illness (Level II), 0.5 beds per 1,000 annual live births; and intense illness (Level III), one bed per 1,000 annual live births. Results are based on the assumption that nonstudy births, 30% of the total, have needs proportionate to study births. The following considerations are necessary to extrapolate these bed needs to other populations: (1) convalescence of intensely ill babies may require that up to 50% of their bed needs may be shifted to intermediate care; (2) compliance with criteria for transport to the next level of care may not be 100% as assumed in the study, thus redistributing bed needs; (3) census characteristically fluctuates in special-care nurseries (study results are reported for an unchanging daily census); and (4) the low birth rate of a population is intimately related to the bed needs.

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Penerapan Clinical Pathways sebagai Instrumen Pengendalian Biaya Pelayanan : Studi Penelitian Tindakan Penderita BPJS yang Menjalani Operasi Caesar dengan Sistem Pembayaran INA-CBG

Jurnal Keperawatan Silampari ◽

10.31539/jks.v4i2.1546 ◽

2021 ◽

Vol 4 (2) ◽

pp. 593-599

Author(s):

Annisa Fitria ◽

Andri Sofa Armani ◽

Thinni Nurul Rochmah ◽

Bangun Trapsila Purwaka ◽

Widodo Jatim Pudjirahardjo

Keyword(s):

Action Research ◽

Caesarean Section ◽

Length Of Stay ◽

Cesarean Section ◽

Clinical Pathway ◽

Average Length ◽

Clinical Pathways ◽

Hospital Costs ◽

Average Length Of Stay ◽

Length Of Hospitalization

This study aims to determine the effect of using clinical pathways to control total actual hospital costs for BPJS patients who undergo a cesarean section. The method used in this research is action research. The results showed that the average actual hospital costs were significantly higher after the application of CP with p = 0.019. The average length of stay, service costs, and hospital costs were significantly lower in the entire CP form group with p = 0.012, p = 0.013, and p = 0.012. In conclusion, this study shows that the application of clinical pathways can reduce the length of hospitalization and actual hospital costs for cesarean section patients and indicates that clinical pathways can make services more efficient. Keywords: Hospital Costs, Clinical Pathway, Caesarean Section

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Internações, óbitos e custos hospitalares pelas intercorrências dialíticas

Revista de Enfermagem UFPE on line ◽

10.5205/1981-8963.2019.240134 ◽

2019 ◽

Vol 13 ◽

Author(s):

Edison Vitório de Souza Júnior ◽

Sarah Rodrigues Silva ◽

Poliana Souza Lapa ◽

Mariana Alves Soledade de Jesus ◽

Michele Silva dos Santos ◽

...

Keyword(s):

Length Of Stay ◽

Kidney Diseases ◽

Average Length ◽

Hospital Costs ◽

Renal Dialysis ◽

The Public ◽

Average Value ◽

Average Length Of Stay ◽

Quantitative Descriptive ◽

Dialysis Complications

Objetivo: descrever as internações, óbitos e custos hospitalares pelas intercorrências dialíticas em pacientes renais crônicos no Nordeste. Método: trata-se de um estudo quantitativo, descritivo e ecológico, voltado para a análise de dados do Sistema de Informações Hospitalares, organizados em frequências absolutas e relativas, a partir de tabelas construídas no software Excel. Resultados: notificaram-se 14.052 internações e 987 óbitos no Nordeste. Gerou-se, como consequência, um custo superior a R$ 19,6 milhões aos cofres públicos, com um valor médio de internação de R$ 1.543,09 e uma média de permanência de 9,1 dias. Destacaram-se os Estados de Alagoas, com a prevalência das internações (38,2%), e Bahia, em relação aos óbitos (40%), custos hospitalares (61,4%), média de permanência (14,4 dias) e valor médio de internação (R$ 2.794,42). Conclusão: aponta-se que as internações e óbitos pelas intercorrências dialíticas constituem um importante problema na Nefrologia, causando prejuízos diretos aos recursos financeiros públicos, especialmente, nos Estados da Bahia e Alagoas, por evidenciarem a maioria dos casos. Descritores: Saúde Pública; Nefrologia; Nefropatias; Diálise Peritoneal; Diálise Renal; Custos de Cuidados de Saúde.Abstract Objective: to describe hospitalizations, deaths and hospital costs due to dialysis complications in chronic renal patients in the Northeast. Method: this is a quantitative, descriptive and ecological study, focused on the analysis of data from the Hospital Information System, organized in absolute and relative frequencies, using tables built using Excel software. Results: 14,052 hospitalizations and 987 deaths were reported in the Northeast. As a result, the public coffers cost over R $ 19.6 million, with an average hospitalization value of R $ 1,543.09 and an average length of stay of 9.1 days. The states of Alagoas stood out, with the prevalence of hospitalizations (38.2%), and Bahia, in relation to deaths (40%), hospital costs (61.4%), average length of stay (14.4 days) and average value of hospitalization (R $ 2,794.42). Conclusion: it is pointed out that hospitalizations and deaths due to dialysis complications are an important problem in Nephrology, causing direct damage to public financial resources, especially in the states of Bahia and Alagoas, as they show the majority of cases. Descriptors: Public Health; Nephrology; Kidney Diseases; Peritoneal Dialysis; Renal Dialysis; Health Care Costs. Resumen Objetivo: describir las hospitalizaciones, muertes y costos hospitalarios por las intercurrencias dialíticas en pacientes renales crónicos en el noreste. Método: se trata de un estudio cuantitativo, descriptivo y ecológico, destinado a analizar los datos del Sistema de Informaciones del Hospital, organizado en frecuencias absolutas y relativas, a partir de tablas construidas en el software Excel. Resultados: se reportaron 14.052 hospitalizaciones y 987 muertes en el noreste. Se generó como resultado de eso, un costo en exceso de R $ 19,6 millones para el gobierno, una hospitalización con costo promedio de R$1,543.09 y una estadía promedio de 9.1 días. Entre los estados, Alagoas tuvo una mayor prevalencia de hospitalizaciones (38,2%) y Bahía en las muertes (40%), costos hospitalarios (61,4%), duración media de la estancia (14,4 días) y media hospitalización (R $ 2.794,42). Conclusión: se observa que las hospitalizaciones y muertes debidas a las intercurrencias dialíticas se constituyen un problema importante en la nefrología, lo que implica directamente en los cofres públicos, especialmente en los Estados de Bahía y Alagoas, como evidencia de una mayor prevalencia de casos. Descriptores: Salud Pública; Nefrología; Enfermedades Renales; Diálisis Peritoneal; Diálisis Renal; Costos de la Atención en Salud. Descriptores: Salud Pública; Nefrología; Enfermedades Renales; Diálisis Peritoneal; Diálisis Renal; Costos de la Atención en Salud.

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The Results of Public Accommodation Establishments in Northern Hungarian Region, with Special Regard to Heves County

Acta Agraria Debreceniensis ◽

10.34101/actaagrar/45/2397 ◽

2012 ◽

pp. 79-82

Author(s):

Róbert Szabó

Keyword(s):

Length Of Stay ◽

Average Length ◽

Pivotal Role ◽

Special Regard ◽

Average Length Of Stay ◽

Revenue Structure ◽

Statistical Indicators

The study shows the results of public accommodation establishments (especially in Heves County) in the period of 2000-2009 in the context of basic touristic statistical indicators like the number of public accommodation establishments, capacity, arrivals, bednights, average length of stay, revenue (structure of revenue). According the study, we can conclude that on the basis of the capacity, number of guests and number of bednights of public accommodation establisments, Heves County (as compared to other counties of the region) played a pivotal role in the tourism of Northern Hungary in the studied period.

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